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GPs confidence in the health reforms is "still in decline" as many view the move towards clinical commissioning groups (CCGs) as a "negative thing" for the NHS.

Furthermore, more than a third (36%) of GPs expect the arrival of CCGs will have an "adverse effect" on the NHS – an increase of 7% from 2011 figures.

The Lloyds TSB Commercial Healthcare Confidence Index also showed a poor appetite for Any Qualified Provider (AQP) services among GPs, with only 28% intending to get involved.

This is compared to 73% of pharmacists who are planning to take up AQP contracts "where possible".

"Confidence has barely improved amongst GPs since the start of the year and overall they have suffered much more than dentists and pharmacists on the back of recent healthcare reforms," said Ian Crompton, Head of Healthcare Banking Services at Lloyds TSB Commercial.

"It's clear from the findings of the latest survey that GPs realise that the sector is set to undergo dramatic changes.

"It is unlikely that we will see any significant shifts in confidence over the next few years. However, GPs need to ensure that they have a strategy in place to deal with the challenges that they will face, whether by purchasing premises or investing in expansion of their service offer."

More than half (58%) of GPs predict there will be more practice mergers, co-locations and larger practices over the next five years.

GPs were also more positive around the purchasing of property, with a 7% rise in the number of those interested in premises ownership in the future (33%).